MEDICARE: DAVID EVERHEART

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center	519519	CA
2	261QA1903X	Ambulatory Surgical Clinic/Center	519519	CA

General Provider Information

NPI Number	:	1336499300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID EVERHEART

Provider Business Mailing Address
First Line	:	1350 E CALETA WAY
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-3324
Country	:	US
Telephone Number	:	949-683-8539
Fax Number	:

Provider Business Practice Location Address
First Line	:	1350 E CALETA WAY
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-3324
Country	:	US
Telephone Number	:	949-683-8539
Fax Number	:

Authorized Official
Title or Position	:	RNFA
Name	:	MR. DAVID PHILLIP EVERHEART
Credential	:	RN CNOR
Telephone Number	:	949-683-8539

Provider Enumeration Date	:	09/17/2012
Last Update Date	:	09/17/2012

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Directions to “DAVID EVERHEART ” Practice Location

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